Comparison of pathological outcomes between robotic rectal cancer surgery and laparoscopic rectal cancer surgery: A meta‐analysis based on seven randomized controlled trials

Abstract

Objective To compare the pathologic outcomes between robotic‐assisted rectal cancer surgery (RRCS) and laparoscopic rectal cancer surgery (LRCS) based on randomized controlled trials (RCTs). Methods Electronic databases were searched from their inception to 7 October 2018, for RCTs involving a comparison between RRCS and LRCS. Positive circumferential resection margin (CRM), distance to the distal margin, proximal margin, the rate of complete mesorectal excision, and harvested lymph nodes were interesting of outcomes. Results The positive CRM, proximal margin, and rate of complete mesorectal excision were comparable between the two techniques. RRCS resulted in better outcomes for the distance to the distal margin (mean difference: 0.83 cm, 95% confidence interval, 0.29‐1.37, P = .003). Conclusions The pathologic outcomes associated with the two approaches were comparable, with RRCS showing better outcomes for the distance to the distal margin. However, additional well‐designed studies are needed to assess whether the benefits of pathologic outcomes improve survival outcomes.

Robotic Surgery for Rectal Cancer: Operative Technique and Review of the Literature

“…Another RCT in Korea also reported [24] that CRM positivity and DM were identified 6.1% and 1.5 cm with RRS and 5.5% and 0.7 cm with LRS, respectively, without a significant difference between the groups. However, Liao et al [52] reported that RRS contributed to better outcomes than LRS with respect to the distance between the tumor edge and DM in a meta-analysis (95% CI, 0.29-1.37, P=0.003).…”

Robotic total mesorectal excision: state of the art

“…Truong et al [73] analysed a retrospective cohort of patients looking at successful resections, defined as a circumferential and distal resection margins < 1 mm and complete mesorectal resection, which were similar between the robotic (75%) and open (76%) approaches [73] . There were no differences in the studies comparing all four approaches for rectal cancer regarding the number of lymph nodes retrieved [26,27,30,69] .…”

“…Liao et al [27] associated the robotic approach with a longer distance to the distal margin in comparison with laparoscopy (MD, 0.83 cm, 95%CI: 0.29-1.37; P = 0.003) [27] . When comparing robotic and open surgeries, no differences were found (MD, 0.17; 95%CI: -0.14 to 0.48; P = 0.27) [69] .…”

“…At the time of the present review, the ROLARR study was the largest RCT comparing robotic-assisted vs. conventional laparoscopic surgery for patients with rectal cancer [26] . Two recent systematic reviews with meta-analyses summarized the outcomes from 7 and 5 RCTs with a similar design [27,28] . Other metaanalyses have been published including also non-randomized clinical trials [29,30] .…”

Milestones in robotic colorectal surgery development: an historical overview

“…Focusing on oncological surgery and setting aside the numerous retrospective studies available, seven RCTs [27][28][29][30][31][32][33] comparing robotic and laparoscopic surgery of the rectum were carried out to present, and their results were summarized by Liao et al [34] in a systematic review with meta-analysis published in 2019. Notably, these authors did not find any significant difference in terms of circumferential resection margins and quality of mesorectal excision, as well as in terms of proximal resection margins and number of retrieved lymph nodes, even if a significant heterogeneity of data was found for these two latter issues.…”